Delayed Cord Clamping – What You Should Know

You’ve probably heard it mentioned. Delayed cord clamping is becoming more and more popular. Showing up on birth plans, even becoming standard practice at some hospitals and birth centers. But why? What’s the evidence behind delaying the snip?

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To understand delayed cord cutting, we first have to understand the functions of the placenta and umbilical cord. The placenta is really an incredible organ, like an organic life support device. There are two sides to the placenta, maternal and fetal. One attached to the uterus and the other to the umbilical cord. There’s constant blood flow to the placenta on both sides.

On mom’s side, blood vessels carry oxygen and nutrients from the mothers body on into the baby. The mother’s blood itself does not pass through. Rather, the life sustaining properties needed for fetal development are extracted via the placenta, into baby’s blood supply. The force of each maternal pulse pushes mother’s oxygen rich blood towards the placenta, and the decrease in pressure between heart beats brings the deoxygenated blood back into mom’s circulation to start all over again.

On baby’s side, blood is sent through the cord to the placenta to process waste, exchange gases, and seek oxygen. It’s a constant, intricate cycle. Mom bringing oxygen and nutrients and taking waste, baby sending waste and seeking nutrients. Naturally, at any given time, there’s a great deal of blood circulating on both sides to support this process.

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This process doesn’t stop during labour and delivery. That blood keeps on pumping until after the placenta detaches. At the moment of birth, a third of the baby’s blood volume remains outside of their body. If left uncut, the cord will slowly turn white after the blood returns back into baby’s body.

This process doesn’t take long. The two arteries and one vein that run through the umbilical cord are efficient at what they do. Even waiting one minute will increase your baby’s blood volume.

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Some parents may choose to wait a set amount of time, wait until the cord turns white, or stops pulsing, or even request the cord and placenta remain attached until they naturally fall away (lotus birth). ACOG states: “Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth (16, 31, 32). This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life (33).

Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits (1, 21, 29, 33–35), including increased blood volume (2, 3, 13, 31, 36–40), reduced need for blood transfusion (17, 22, 41), decreased incidence of intracranial hemorrhage in preterm infants (10, 18, 29), and decreased frequency of iron deficiency anemia in term infants (7–9, 13, 24–26, 35–37, 40, 42).”

Cord Milking (see video below) is another option to consider. It involves manually aiding the process by squeezing the cord in swipes towards the baby. This encourages greater blood volume transfer in a shorter amount of time. It may look a bit rough, but rest assured the cord has no nerve endings and the process will be sensation free for both of you.

We’ve talked about why you should consider DCC, but why might a parent choose to clamp immediately? Some parents may fear DCC isn’t an option for their birth. As seen above, DCC is an option in surgical births. This would vary depending on hospital policy, so its wise to touch base with your OB ahead of time. Typically in a surgical birth with DCC baby would remain between mother’s legs while the surgeons wait for the cord to stop pulsing. If immediate  skin to skin in the OR is important to you, you may wish to opt out of DCC.

A premature or medically fragile newborn is not necessarily a deal breaker for DCC. There’s evidence to suggest delayed clamping actually improves outcomes in cases requiring resuscitation. There will be exceptions, however, when a baby needs immediate NICU transfer with no time to wait. Some hospitals are adopting bedside resuscitation, which offers the best of both worlds in terms of prompt medical care for neonates in need and keeping close proximity to mother and delaying clamping when possible.

When birthing multiples, it may not be possible to delay cord clamping while caring for the medical needs of baby A, and delivering baby B. This will depend heavily on spacing between births, the stability of the babies, and the policies of the attending physician. Ask questions prenatally to determine if DCC is likely to be an option for you.

Some parents are concerned they won’t be able to bank their baby’s cord blood if they delay clamping. This is a real risk. Delaying clamping will result in much less blood available to collect for banking purposes. Banks will still accept any blood they’re able to collect, but its impossible to predict whether there will be a sufficient amount.

While there are very few medical risks involved in the practice of delayed clamping, some studies show babies have a higher risk of jaundice following DCC. 3% of newborns with immediate cord cutting require treatment for jaundice, as opposed to 5% of babies with delayed clamping.

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To clamp, or not to clamp. It’s up to you to decide. Like all matters involving your medical care, be sure to ask your healthcare provider for more information.

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